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Tuberculosis Research and TreatmentVolume 2011 2011, Article ID 798764, 9 pages

Review Article

Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045, USA

Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045, USA

Denver Veterans Affairs Medical Center, Denver, CO 80220-3808, USA

Department of Medicine, National Jewish Health, Denver, CO 80206, USA

Program in Cell Biology, National Jewish Health, Denver, CO 80206, USA

Received 3 September 2011; Revised 16 November 2011; Accepted 18 November 2011

Academic Editor: Carlo Garzelli

Copyright © 2011 Grace E. Marx and Edward D. Chan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Tuberculous meningitis TBM is the most common form of central nervous system tuberculosis TB and has very high morbidity and mortality. TBM is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Characteristic cerebrospinal fluid CSF findings of TBM include a lymphocytic-predominant pleiocytosis, elevated protein, and low glucose. CSF acid-fast smear and culture have relatively low sensitivity but yield is increased with multiple, large volume samples. Nucleic acid amplification of the CSF by PCR is highly specific but suboptimal sensitivity precludes ruling out TBM with a negative test. Treatment for TBM should be initiated as soon as clinical suspicion is supported by initial CSF studies. Empiric treatment should include at least four first-line drugs, preferably isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol; the role of fluoroquinolones remains to be determined. Adjunctive treatment with corticosteroids has been shown to improve mortality with TBM. In HIV-positive individuals with TBM, important treatment considerations include drug interactions, development of immune reconstitution inflammatory syndrome, unclear benefit of adjunctive corticosteroids, and higher rates of drug-resistant TB. Testing the efficacy of second-line and new anti-TB drugs in animal models of experimental TBM is needed to help determine the optimal regimen for drug-resistant TB.

Autor: Grace E. Marx and Edward D. Chan



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